Study Purpose:

To compare the effectiveness of a cognitive-behavioral therapy (CBT) group intervention versus a relaxation and guided imagery (RGI) group training intervention.

Intervention Characteristics/Basic Study Process:

The intervention groups received nine 90-minute weekly sessions, and the control group received standard care. The outcomes measured were psychological distress, sleep, fatigue, and health locus of control.

Sample Characteristics:

The study was comprised of 170 patients with stage I or II breast cancer.

Patients were between two and 12 months since surgery and were receiving treatment (chemotherapy or radiotherapy).

Setting:

Oncology center in northern Israel

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Study Design:

This was a randomized, controlled trial.

Measurement Instruments/Methods:

Brief Symptom Inventory (BSI)

Fatigue Symptom Inventory (FSI)

Perceived Stress Scale-10-item (PSS-10)

Mini Sleep Questionnaire (MSQ)

Multidimensional Health Locus of Control (MHLC)

Global Severity Index (GSI)

Adherence questionnaire with a Likert scale

Results:

GSI and perceived stress decreased in both intervention groups but not in the control group. Means of fatigue symptoms and sleep difficulties decreased in both intervention groups but only significantly in the RGI group. External health locus of control decreased more in the CBT group. No differences were observed among groups in internal locus of control. Participants in the RGI group reported significantly higher self-practice adherence at home than did those in the CBT group.

Limitations:

Fifty-six of the 170 patients were excluded from the analysis due to missing more than two meetings or not completing questionnaires.

The study required a therapist trained in CBT and RGI.

The method of recruiting participants may have affected the generalizability of the results.

The follow-up should have been for longer periods and with more assessment points.

Nursing Implications:

A study design with four groups—CBT, RGI, combined CBT and RGI, and control—could shed light on whether combining CBT and RGI is more advantageous than delivering either intervention individually.